Provider Demographics
NPI:1861614497
Name:JEWELL, BRAD J (RPH)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:J
Last Name:JEWELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49560 NATURE TRAIL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9298
Mailing Address - Country:US
Mailing Address - Phone:740-695-2611
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006036183500000X
OH03-3-21924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist